Medtronic plc

Welcome to Junco's facility in Puerto Rico. This is the facility that we are manufacturing Altaviva, the new Pelvic Health product. Altaviva is a tiny product that is going to be implanted in the ankle and is for patients with urinary incontinency. Technology is a driving force in our production floor. Every time that we manufacture the product, we are thinking on the patient. We are going to approach to the gowning room where the magics begin. We need to make the product in a controlled environment to make sure that the product that we are sending out for the patients are meeting the specification in order to provide the right therapy for the patients. So this is the first step of Altaviva. So in here, we receive the main parts of Altaviva, which is the feed-through. That feed-through is the connection between the electrode and the internal components that actually lead or drive the therapy to the patients.

We're going to be welding together those feed-through wires to the circuitry of the device. When it comes back around, it's going to be nice and engraved with the Medtronic logo, the serial number, and the brand name for the part. Now we're going to the final part of the manufacturing assembly. These testers are going to be handling the final functional testing of the parts.

My father got an ICD from here. You never know when a family or a relative is going to end up with a product from here. So not only the operators, but the engineers, technicians, everyone. We are thinking patients all the time.

Urge, urinary incontinence is something that no one wants to talk about. But since getting the AltaViva implant, I feel like a new person.

We're busy people. We like doing a lot of things. We just try to have a busy, retired lifestyle.

I play golf when I can, write poetry, fish when I can. You can have this joyous look, but inside you know, I've got this issue. It's been for years, I'd say over 20 years, dealing with it.

He was always going to the restroom. I mean, constantly. It was pretty bad. He was always so frustrated.

When you have to go or when you're rushing to go or when there's incontinence, you're like, why? Why me? Why'd I always have to go to the bathroom? It's depressing. It brings out a sense of anxiety. because you know what's about to come and then when it does come, you know that you have to change what you're doing or stop what you're doing, because you have to go. Especially if I'm driving, your thoughts always are on, here I go again, here I go again. Why am I the only one that has to do this? As men, we minimize everything because if it's not drastically changing your life, then you just deal with it. We don't have to suffer in silence. And it wasn't until later in life that I was able to seek treatment. Their initial treatment was through, you know, the pills. And you take that, but then you're like, man, these side effects are crazy. I mean, it dried me out. It just messed up my life. And then I go, I don't want that anymore. What led me to where I am today is, you know, they introduced, hey, we have this device. And for me, it was a no-brainer. You don't stop to think about what they're going to do or how they're going to do it if this works. It's better because if I can reduce it at any cost, I'll do it. And it's been for me night and day. It was a very easy procedure. There's a small incision and it's placed right behind your ankle. And before I know it, she was stitching it up. And I'm like, that's it? You're in and out. I'm not worried about leakage. I'm not worried about the urgency anymore. And I'm not worried about where I'm at. So now I can enjoy the moment without thinking or worrying about this is going to come up and interfere with what I'm doing at the time.

I don't even notice it now because he never talks about going to the bathroom. It's nothing like it used to be.

Everything was affected before. Now there's a new me that doesn't have that problem. It's a game changer, it's there. And I don't even really know it, but it means a lot as a man, as a person to feel that there is something. There's a remedy that's minimally invasive, doesn't stop the things that you do in life, but will help you. The AltaViva implant helped me become me again.

When our competition says, oh, you haven't been innovating, they haven't been paying attention. We've been innovating the whole time.

It's not just a product. It really does change the way people do surgery, and it changes the patient's lives for the better.

Think about what a neurosurgeon does. Why not use the precise instrument, particularly for the procedure in which you're operating on the most complex structure of the universe?

So when I first saw the early version of what would become the cell station, I was impressed.

I mean, it was one of those things that when neurosurgeons saw it for the first time, they thought it was a miracle. And our booth at our first exhibit shows always had a line.

It honestly went from a curiosity to something that's become incredibly useful. You don't have to take my word for that. You can just look around the world and see how many lives have been impacted by stealth.

You'd probably put the space back decades without stealth.

There's no other technology offering that combines planning, navigation, robotics in the way it does in scalable different modules for site of service the way that Axis does.

We're going to do things that people didn't think existed.

We are the trailblazers. We are the innovators. We built this market. If it weren't for Medtronic, this journey wouldn't be what it is.

In surgery, your skill and intuition are the epicenter of a patient's outcome. Now, your expertise is fully matched by a surgical system that works with you, precisely, instinctively, seamlessly. Backed by decades of industry-leading innovation, optimized for familiar and flexible workflows with real-time accuracy you can rely on, designed to elevate, built to expand, allowing you to operate at the highest level. When surgery is more connected, care becomes more complete, redefining what's possible for every patient. A new era of surgery starts here. Innovation revolves around a new axis, stealth axis. Thank you.

Having multiple different platforms, a modular and then a non-modular, is really exciting. The difference from the previous systems is that this is very flexible and therefore the modular system allows to pick and choose the components you want to use. It gives us a lot of customization to the surgeon according to their patient and the requirements.

My name is Danny Cash, and this is my wife, Teresa. Motorcycles, snowmobiles, jet skis, side by sides, we travel and do adventures every chance we get. When you have high blood pressure, you just don't feel well. You don't get enthused to go out and do an adventure. I took medications and it was a, let's try this and see how that affects you. So it was a couple of years of trial and error and taking the medications over and over just became a burden.

And he was struggling. He had side effects. He had the flushing, the headaches.

My doctor recommended the Simplicity blood pressure procedure in order to not have to take any additional medicines to control my blood pressure. It was a simple procedure. I came home and took it easy for a couple of days and then I was good to go.

He's thankful that he was able to get the simplicity procedure and that that has not slowed him down. Any adventure, he wants to do it.

I'm getting older every day and I want to enjoy every day that I have. The procedure has been extremely beneficial in my ability to stay young and do adventurous things. There's plenty of time later to sit around, but right now I want to go, go, go.

Good morning, and welcome to our fiscal 26 fourth quarter earnings webcast. I'm Ingrid Goldberg, head of Medtronic Investor Relations. I'm joined by Jeff Martha, chairman and chief executive officer, and Thierry Petain, chief financial officer. Jeff and Thierry will provide comments on the results of our fourth quarter, which ended on April 24th, 2026, and our outlook for fiscal year 27. After our prepared remarks, we'll take questions from the sell-side analysts that cover the company. Earlier this morning, we issued a press release discussing our quarterly results and several financial schedules. We also posted an earnings presentation that provides additional details on our performance. The presentation can be accessed in our earnings press release or on our website at investorrelations.medtronic.com. During today's program, many of our statements will be forward-looking, and actual results could differ materially as explained in our SEC filings. We undertake no obligation to update any forward-looking statements. Unless otherwise stated, all comparisons are on a year-over-year basis, and revenue comparisons are made on an organic basis, which excludes the impact of foreign exchange, prior year revenue from the divestiture of the Dutch obesity clinic, also known as NOK, and fourth quarter revenue in the current and prior year reported as other. References to sequential revenue changes compared to the third quarter of fiscal 26 and are made on an as-reported basis. all share references on a revenue and year-over-year basis and compare our fourth fiscal quarter to our competitor's first calendar quarter. Reconciliations of all non-GAAP financial measures can be found in our earnings press release or on our website at investorrelations.medtronic.com. And finally, our EPS guidance does not include any charges or gains that will be reported as non-GAAP adjustments to earnings during the fiscal year. With that, I am now pleased to hand it over to Jeff.

OK, thanks, Ingrid. And good morning, everyone, and thank you for joining us. In our fourth quarter of fiscal 2026, we delivered $9.8 billion in revenue, up 9.9% on a reported basis, and 6.6% organically. So for the full fiscal year, we delivered $36.4 billion in revenue, up 8.4% reported, and up 5.8% organically. marking our strongest top-line performance in 10 years. And on the bottom line, we delivered Q4 and FY26 adjusted EPS of $1.55 and $5.53, respectively, ahead of expectations and reflective of our commitment to operational rigor as we invest in durable growth. These results represent the compounding impact of deliberate choices we've made across strategy, operations, and culture. We saw continued strong execution across our largest foundational businesses like CRM, CST, and surgical. and we made material progress on our highest growth platforms. We marched toward leadership in CAS, advanced simplicity and Hugo, and built momentum in AltaViva and Stealth Access, all while supporting our uniquely deep pipeline of innovation. In Q4, we advanced our commitment to further focus the company, deploying capital in line with our capital allocation priorities and meaningfully increasing our investments in M&A, ventures, and partnerships. And I am incredibly proud of our teams. Through a dynamic macro environment, we have executed and we've executed with discipline to deliver an excellent fiscal 26 that will continue into fiscal 27. And now let's turn to the details of our fiscal fourth quarter, beginning with cardiac ablation solutions. Look, CAST delivered another outstanding quarter with 78% worldwide growth and gaining an additional eight points of US share. PFA saw exceptional global growth of 145%, with Sphere 9 continuing to demonstrate broad versatility. And we're still in the early innings for Afera. In the US, we increased our installed base by 40% sequentially, and we see significant runway for continued expansion. Globally, we're now rolling out Prism 2, our next-generation mapping software. Prism 2 unlocks meaningful benefits, including improved navigation using hybrid impedance and magnetic mapping to better visualize non-sensor-based catheters. As we look ahead, we're expanding our entire EP ecosystem, expanding geographically into new indications and with an exciting cadence of new innovation. In Q4, we launched Sphere 9 in Japan, where we expect to extend our market leadership. We also secured FDA approval for our US VT pivotal trial, which we aim to begin enrolling in the first half of FY27. This is an important population due to the complexity of these potentially life-threatening arrhythmias that are often really difficult to treat. Now, further strengthening our EP offering is our Sphere 360 catheter, the only rotation-free, large tip, single shot catheter that's available. Sphere 360 is CE-marked and launching in Europe. Early physician feedback is really strong, and our US pivotal trial is enrolling swiftly. And as you saw in our additional press release this morning, we are continuing to invest in a fully integrated EP ecosystem with two targeted investments in ice catheter technology that will give physicians real-time visualization of the heart. This will further enhance the Afera platform over time to extend our capabilities. Now, through innovation, purposeful investment, and global execution, we plan to completely surround the electrophysiology space and offer patients and physicians a more complete end-to-end set of EP solutions. Next, I'd like to share our progress with Simplicity Spiral, which is a novel, one-time, minimally invasive approach to treat hypertension. Hypertension represents a massive unmet need. Now, despite the use of multiple medications, roughly 18 million people still live with the uncontrolled hypertension in the US alone. Our Simplicity Physician Finder now spans 200 doctors across more than 300 accounts, connecting patients with physicians as demand grows. We've also seen a significant uptick in prior authorization approvals. And since the NCD, we have doubled average weekly procedure volumes. And now Simplicity is annualizing at $100 million. At CRT this year, we presented late-breaking, long-term data reinforcing the clinical outcomes of RF renal denervation. In over 2,000 patients, Simplicity delivered sustained mean systolic blood pressure reductions of 13.3 and 18.1 milligrams of mercury in ambulatory and in-office settings at three years, respectively, with 90% of patients achieving a meaningful benefit. And as a reminder, a 10-point reduction in BP is proven to show a greater than 20% reduction in major cardiovascular events like heart attack, stroke, and heart failure. So this is critical and underscores the impact of simplicity on patients and the health care system itself. Importantly, we stand apart as the proven platform in a category with enormous unmet need. and we intend to lead it. We are confident in the foundation we've established with robust and growing clinical evidence, a broad label, expanding reimbursement, and growing demand from both physicians and patients. We are well positioned and in the early stages of this ramp to redefine the standard of care in a historically drug-based setting with a new option for managing hypertension. Now we're also starting to see meaningful impact from Hugo, our surgical robotic system. Our worldwide procedure volume growth is two to three X the market and utilization is increasing. Last quarter, we launched Hugo for urology in the United States, placing systems at leading institutions and treating our first patients. Feedback from surgical teams has been positive, both in terms of their experience and early clinical outcomes. We are pleased to announce that in late April, we submitted to the FDA for 510 clearance for general surgery and gynecologic indications, as well as for our ligature RAS vessel sealer. We also recently received FDA clearance for our ProGrip Advanced, a new mesh optimized for robotic-assisted ventral hernia repair procedures. And our touch surgery digital ecosystem, well, it continues to represent a clear advantage, with over 1400 installations, up 30% plus sequentially. We are complementing our strong foundation with data and analytics, driving a more precise, intelligent, and a predictable future in surgery. Digital is creating real value in the OR, and we are investing and innovating to lead in this space. We are building our robotics program deliberately. We are driving utilization and procedure growth globally, making steady progress in the United States, and investing to strengthen our broader surgical franchise over time. Hugo is having an impact on our med-surg portfolio, and we are pleased with the early progress. Now moving to AltaViva, momentum here continues to build and we are encouraged by the strong physician feedback and early patient demand. AltaViva redefines what is possible for patients with urge urinary incontinence with same day activation. up to 15 years longevity and full-body MRI access while the device remains on, patients can start therapy sooner and live life with fewer disruptions. We've trained nearly 1,000 physicians since launch, and that investment is starting to translate into commercial momentum. Sequentially, active implanters are up three times, and patients treated are up two and a half times. Importantly, as physicians gain more experience and move through prior authorization more swiftly, implants are accelerating. Finally, we executed our focused portfolio strategy. In early March, we completed the MiniMed IPO, establishing it as a standalone publicly traded company. We also advanced our M&A and venture initiatives, targeting higher growth segments to accelerate innovation in markets where we have a right to win. In our coronary portfolio, we closed on the CathWorks transaction. CathWorks FFR-Angio system uses a combination of AI and advanced computational science to improve decision-making in the cath lab. The company recently presented positive one-year data from the AllRise trial validating FFR-Angio as a non-invasive technology poised to disrupt the gold standard traditional wire-based FFR. which is a $1 billion segment growing in the low double digits. We announced plans to acquire Scientia and SPR Therapeutics, as well as investments in Beluga Medical and Cardioac. Scientia will meaningfully expand our neurovascular platform with differentiated guidewire technologies for stroke, enabling every neurovascular procedure to start with Medtronic. SPR Therapeutics for PNS will build out our portfolio of chronic pain management therapies. And Beluga Medical and Carduac will advance development of next generation ice catheters that will further advance our EP toolkit. In our venture portfolio, we invested in emerging technologies, including Polnovo, a first of its kind, minimally invasive system designed to address pulmonary artery denervation. And we entered into a distribution agreement with Merit Medical for ViaVerte, which brings an FDA-cleared solution for chronic vertebogenic back pain. Now, both of these transactions will expand our reach into new and high-growth adjacencies where we hold leadership positions. These investments are deliberate and tightly aligned to our strategy of reinforcing leadership positions, building scalable ecosystems, and extending our reach and attractive markets. Together, these meaningful tuck-in investments position us to drive sustainable growth for the near and the long term. Now, these are just a few highlights from the quarter. Looking across the business, multiple operating units contributed to the strength in Q4, like CST with Stealth Access, or CRM with Omnia Secure and Mycra, and many others, which Thierry will cover in more depth. So to close, I want to start with thanking our teams, not only for delivering a strong year, but embracing the changes that have enabled this performance. In a world with many moving pieces, we are executing. We are delivering. We are delivering on our strategic priorities and accelerating access to life-changing therapies, all while creating meaningful value for patients, for physicians, for healthcare systems, and for our shareholders. Now, with that, I'm going to turn it over to Thierry. He's going to walk through the financial results of both the quarter and the full year before turning to guidance. Thierry?

THIERRY BOUCHARDT- Hey, thanks, Jeff. And hello, everyone. I appreciate you joining today. Let's start with cardiovascular, which delivered 10% revenue growth this quarter, led by 14% in the US and 7% in international markets. Driving this performance was 78% growth in CAS, including 124% in the US. In a 14 billion market that grew about 20% in 4Q, we're now annualizing over 2 billion in revenue and are on track to reach 2 billion trailing in the first quarter of fiscal year 27. Cardiac rhythm management delivered 5% growth in both U.S. and international markets. Defibrillation delivered mid-single-digit growth, including high teens in ICD and mid-60s in EVICD. We saw strong momentum in the recently launched Omnia Secure Defibrillation Lead following our indication expansion that allows for conduction system pacing. Cardiac pacing therapies delivered mid-single-digit growth, driven by mid-teens and micro, and high teens in the select secure 3830 lead for CSP. Turning to structural heart, performance in the quarter was flat. We saw strong international performance, while the U.S. was softer, in part due to the low risk data. We're encouraged though by the trajectory we've seen in the field as weekly US procedure volumes have stabilized over the last eight weeks. Structural hard clearly remains a strategic priority for us with internal programs in mitral and tricuspid replacement and targeted external investment in TAVR, including anteris paving the way forward. Coronary declined in the quarter, but was offset by strength in renal denervation as described by Jeff. Importantly, we saw clear acceleration of simplicity in the back half of the year. We're pleased to see the sequential lift and feel well positioned to drive momentum going forward. Finally, peripheral vascular health delivered low single digit growth and cardiac surgery was up mid single digit. Moving to neuroscience, our position in neuroscience is strong. We have the most comprehensive portfolio and are the number one player and category leader across each of our segments. We're investing across the portfolio to advance pipeline innovation and accelerate long-term growth. This quarter, we delivered 3% revenue growth globally, driven by 6% in international markets. Cranial and spinal technologies was up 3% in both U.S. and international markets. Core spine gained share this quarter, growing 6% on continued module X expansion and distributor conversions. In neurosurgery, results improved sequentially, supported by low double-digit growth in navigation following the launch of stealth access late in the quarter. Stealth access platform is an important growth driver for our CST business. The early commercial launch is progressing well, physician feedback has been very positive, and sales are off to a very strong start. This quarter, we achieved FDA clearance across spine, cranial, and ENT indications, as well as CE mark for spine and cranial, broadening the platform's reach across our portfolio. Look, Stealth is a force multiplier, driving pull-through across planning, robotics, and our broader Able ecosystem. It promotes the adoption of robotics in spine surgery, creates efficiencies that allow more physicians to integrate it without disrupting workflow. All of this makes our install base stickier over time. With robotics penetration still in the high single digits, we see significant runway ahead. Specialty therapies delivered 3% growth. Neurovascular was up 6%, driven by 11% growth in hemorrhagic, including healthy adoption in NeuroGard and RTs. We are actively investing in neurovascular, as evidenced also by our planned Scientia acquisition. Scientia represents a significant advancement in navigation, enabling neuro-interventionalists to reach areas of the brain that were historically extremely difficult to get to. ENT delivered another quarter of mid-single-digit growth, including high single-digit in international markets. In pelvic health, results were flat as solid growth in AlteViva was offset by broader market softness and sacral nerve modulation. Given the progress our teams have made, we look forward to seeing AlteViva continue to scale into 2027. Finally, neuromodulation was up low single digit. This is another area of strategic focus and investment as demonstrated by our expansion in BVNA and planned acquisition of SPI Therapeutics, an attractive space growing over 20% annually. Now turning to medical surgical, which delivered 5% growth globally, including 8% in the US. Surgical revenue increased 3% globally, split evenly between the US and international markets. Performance was driven by high single digit growth in both advanced energy and wound management, as well as an increased contribution from Hugo. This was partially offset, like in prior quarters, by continued pressure in bariatrics. Endoscopy delivered high single-digit growth, driven by strong adoption of endoflip in the U.S. and Western Europe, and market share gain in Nexpowder in the U.S. And then acute care and monitoring was up 11%, including high teens growth in the U.S. Results were driven by mid-teens growth in Nelcor pulse oximetry, high single-digit growth in respiratory and airways, as well as mid-single-digit in perioperative. The outside strength we've seen in ACM was a positive tailwind to the quarter. Looking ahead, we anticipate this growth to normalize as we head into fiscal year 27. Overall, we are very pleased with the Finnish medical surgical had to close the year. Running out with the diabetes business, we completed the MiniMed IPO during the quarter, marking an important milestone in establishing MiniMed as a standalone publicly traded company. For the quarter, the diabetes business delivered 15% reported growth or 8.1% organic, driven by strong international execution and continued momentum in U.S. CGM and new patient starts as the team prepares for the commercial launch of MiniMed Flex during the summer. Look, we're excited to see the MiniMed team share more detail on their first earnings call later this morning. Before we move into the details of Q4 and guidance, I'd like to remind everyone that the diabetes financials, as reported by Medtronic, are prepared on a different basis than the standalone MiniMed ones. Accordingly, you cannot precisely estimate Medtronic-Romenco financials by subtracting one set of financials from another. As with prior similar transactions post-split, when Medtronic is no longer the majority shareholder of Minimed, we will provide Medtronic guidance that will reflect updated operational performance metrics and share count. Now turning to financials, revenue this quarter of 9.8 billion grew 9.9%, reported, or 6.6% organic. This represented a 60 basis points acceleration from last quarter on a far more challenging comp. This caps the strongest annual performance we have seen in 10 years. Geographically, performance was balanced with 7% growth in the US and 6.2% internationally. Before I turn to the P&L, I want to pause and take a moment to acknowledge our Medtronic colleagues, especially those in the Middle East and impacted countries who, despite the ongoing conflict, have remained focused on serving our customers and our patients. Their performance under tremendously difficult circumstances reflects their commitment, resilience, and the strength of our mission and culture. So thank you. On that note, I will now turn to walking us through the fourth quarter P&L. Our adjusted gross margin was 65.4%, up 30 basis points year over year, and up 50 basis points sequentially. Let me walk you through the elements shaping gross margin this quarter as I usually do. Similar to Q3, our disciplined pricing provided 30 basis points benefit. Net of inflation cost down contributed 60 basis points driven by COGS efficiency programs as our portfolios, global operations and supply chain teams delivered material savings, improved efficiencies and higher yields. Mix was unfavorable by 60 basis points, largely reflecting the diabetes business, as well as higher mix of lower margin capital to higher margin catheters in our CAS business. While a near-term headwind to gross margin rate, this represents a favorable leading indicator as it reflects further penetration of the market and strong pull-through potential for future catheter sales. Tariffs impacted the business by $74 million, or 80 basis points, in line with expectations. And finally, foreign exchange was an approximate 80 basis points tailwind. Moving to overhead, adjusted R&D was roughly 7% of revenue in the fourth quarter and fiscal year R&D grew 150 million as we marched towards higher investment goals. Q4 to date, we closed or announced nearly 2 billion of additional investments as we executed on M&A and venture capital strategy. We expect recent M&A to contribute approximately 150 million to inorganic revenue growth in fiscal year 27, and to be a healthy contributor to our organic-based in the out years. Within our venture portfolio, we also made 16 venture investments this fiscal year, totaling approximately 250 million. Each of these investments are in growth accretive adjacencies and should generate strong returns and potential acquisition opportunities in the years ahead. We're committed to accelerating our pace of innovation and top-line growth through a prudent and strategic combination of organic and inorganic investment. Adjusted SG&A was 30.5% of revenue in the quarter, up 30 basis points year over year. With favorability below the line, this quarter we made the deliberate decision to accelerate investment in our commercial firepower to support our key growth areas. Our adjusted operating profit was 2.5 billion, resulting in an adjusted operating margin of 25.5%. This included impacts of 160 basis points from the MiniMed Blackstone payment and 80 basis points from tariffs. Our adjusted tax rate was 17.7%, slightly better than expected. All in all, adjusted EPS was $1.55 above the midpoint of our guidance range and above the street expectations. Free cash flow was 5.4 billion in fiscal year 26, the strongest it has been since 2022 and ahead of our expectations. We've made solid progress in working capital over the year. The team delivered notable progress in accounts receivable and controlled inventory effectively. Our capex spend was up roughly 50 million and grew at a significantly lower rate than revenue. Because of this, we ended the year with a $9.2 billion in cash and investments, positioning the company very favorably to execute on M&A opportunities. Look, our performance this year underscores the strength of our portfolio and the consistency of our execution. While we faced headwinds like tariffs and a transitional product mix, we made meaningful progress in our efficiency initiatives, driving COGS improvements, and achieving gross profit leverage ex-tariffs. Importantly, we remained disciplined in balancing performance with investment. We purposefully increased investment in SG&A, R&D, and M&A to support innovation and commercialization in some of the most attractive and durable growth markets in MedTech. I'd like to thank our teams for all the progress made this year, and I look forward to seeing this momentum carrying into the next fiscal year. Speaking of 27, now turning to the guidance. I want to note that our four-year guidance continues to include the diabetes business, as Medtronic remains the majority shareholder of MiniMed through the split-off process. Today, we're guiding fiscal year 27 organic revenue growth of 6.75% to 7.25%, including approximately 11.5% to 12% organic growth in the first quarter. This guidance includes a roughly 25 basis points tailwind from the diabetes business. It also incorporates the benefit from the additional selling week, which is recognized in the first fiscal quarter. We expected to contribute approximately 125 basis points to the four-year growth and 500 to 600 basis points in the first quarter. Additionally, based on recent FX rates, we expect the foreign exchange to be a neutral to roughly 100 million headwinds for the full year, with an approximate neutral to 50 million tailwinds to the first quarter. Moving down the P&L, we expect our fiscal 27 margin to be roughly in line with the previous year, excluding tariffs. Pricing and COGS efficiency programs are expected to offset the impact of business mix, primarily from diabetes. This pressure point will disappear upon separation. We anticipate a tariff impact to COGS of approximately 250 million in total, including 75 million in the first quarter. Including tariffs, we expect fiscal year 27 gross margin to decrease by roughly 20 basis points. We continue to invest in innovation to accelerate the launch of key products. This includes incremental spend as we integrate several acquisitions. Overall, we expect our fiscal 27 operating margin to be up 60 basis points, driven by the absence of Blackstone milestone payments we saw this year, and operating leverage. Below the operating profit line, we're expecting an approximate 200 basis points headwind, driven by an increase in net interest expense, as well as a slightly higher tax rate. We're guiding 27 EPS of $5.90 to $6. Fiscal year 27 incorporates several dynamic components, and I would like to be explicit around our assumptions on the inputs. We have included an approximate 150 basis points benefit from the extra selling week to the full year. Because we do not yet know the timing of the MediMed separation, we're taking a conservative approach and including the full year of the diabetes business in our estimates, including the associated monthly dilution and assuming no separation share count benefit in fiscal 27. Should we separate prior to the year end, as per our intent, we could see potential upside from our current guidance. We're factoring 2% dilution from M&A, which is roughly one point higher than what we shared last quarter, as the timing of several of our deals actually occurred earlier than anticipated. We're taking the full tariff impact of 250 million, as mentioned previously, an increase of 65 million versus prior year. We have not taken into consideration any government refund. We've embedded also a roughly one point headwind from increased fuel and transportation costs due to the conflict in the Middle East. And finally, based on recent FX rate, we expect foreign exchange to have a neutral to 1% accretive impact for the four year. For the first quarter, we would expect EPS in the range of $1.38 to $1.40, including a 600 to 700 basis points benefit from the extra selling week, as well as roughly neutral impact from foreign exchange at recent rates. Look, all of this taken together, our approach to guidance for the full fiscal year positions us well for a strong performance in 2027. And with that, back to you, Jeff.

Okay, thanks, Thierry. Now, as we come to a close, I'd like to take a step back. The macro backdrop, as you know, has been challenging and dynamic. But medtech is structurally resilient because the fundamentals are durable. People are living longer, chronic disease is rising, and the demand for medical procedures will only grow. AI, digital, robotics, as well as advanced electronics are meaningful accelerants. And at Medtronic, we are uniquely positioned to integrate these technologies for safer care, improved outcomes, and stronger healthcare economics that scale globally. I also want to take a moment to recognize Brett Wall, who will be leaving Medtronic this summer following an extraordinary 25-year career. Brett has been an integral part of our leadership team and played a defining role in shaping our neuroscience portfolio, including helping establish interventional stroke as a global standard of care and advancing innovation across neuromodulation. His impact on patients, on our strategy, and our culture, it's been significant. and we are deeply grateful for his contributions. As part of this plan transition, Dr. Qualey-Thompson will step into the role of Executive Vice President and President of our neuroscience portfolio. Qualey is a proven leader with a strong track record of execution, deep clinical and operational experience, most recently leading our CRM business. He is well positioned to lead neuroscience into its next phase of growth. Again, we want to thank Brett for his leadership, and we look forward to Qualey's continued impact So we delivered a strong finish to the year, powered by the breadth of our portfolio and disciplined execution across the business. And look, we are not letting up. We are investing in the future. We are building momentum in our key growth areas, advancing innovations across the portfolio, and deploying capital through targeted M&A, ventures, and partnerships. Together with strong commercial execution and market development, these actions give us confidence in our ability to deliver durable, innovation-led growth for FY27 and years to come. With that, let's turn to Q&A. Ingrid, can you please provide the instructions and queue up the analysts?

For the sell-side analyst that would like to ask a question, please select the Participants button and click Raise Hand. If you're using the mobile app, press More and select Raise Hand. Your lines are currently on mute, and when called upon, you'll receive a request to unmute your line, which you must respond to before asking your question. Finally, please be advised that this Q&A session will be recorded. We'll pause for a few seconds to assemble the queue. We'll take our first question from Vijay Kumar at Evercore. Vijay, please go ahead.

Hey guys, thank you for taking my question. And Jeff, congrats on a nice sprint here. Maybe Jeff, I'll start with the guidance question. Fiscal 27, excluding the extra week, I think underlying five and a half to six, that's an acceleration in line with the prior assumptions. I think as cash slows down, that's been a concern for the market, right? Can you just talk about what are the offsets, which segments accelerate to offset cash and drives the confidence in this five and a half to six organic?

Well, thanks for the question, Vijay. Let me just start with the CAS comment you made. And then I'm going to turn it over to Tierney to answer the ins and outs and puts and takes of the guidance question. But on CAS, look, the impact of CAS to our growth will be very similar next year to this year. I mean, we see the market in FY27. Well, first of all, in Q4, we think the cash market grew around 20%. In FY27, we're thinking mid to high teens market growth. And we're going to grow north of two times that of the market rate. And again, the business has gotten a lot bigger. So its contributions to our growth are even more because of the size. Yeah, so we're annualizing. That business is annualizing now $2 billion. We're going to hit that $2 billion backward-looking revenue mark that I laid out there. We're going to hit that in Q1. We're about 15% share right now and marching towards market leadership and cash. So I don't... We're not... You know, look, we're not talking about cash slowing down or its impact on our growth. I just laid out what I think it will grow, but the impact is strong. So I just want to clarify that first, and then maybe, Thierry, you talk about the guidance.

Sure. Hi, Vijay. So, look, just maybe to give you a couple components of the growth rate here. The cardiovascular business should have a performance next year that's pretty much in line with what we've seen in 26. So it's got really, really strong momentum. Jeff just talked about CAS. We're clearly still in the early innings of the CAS development here. You probably saw in in the commentary that from an install base perspective, the install base was up 40% in the fourth quarter alone. So that gives us a ton of headroom to grow the catheter cells going forward. CRM will continue to be a strong mid-single digit. We have a lot of strength coming from innovation, from Micra, from Omnia. from EVICD, and that's going to carry into 27. And then, you know, staying in the cardiovascular portfolio, we expect to continue to see some strong lift coming from Ardian. You know, so Ardian is now annualizing about 100 million revenue a year, and we expect that to continue to grow significantly into 27 and beyond. And then we've incorporated a prudent guidance for structural heart. As we mentioned in the commentary, the business has been pretty stable over the last weeks. And that's what we've incorporated in the guidance going forward. So strong continuation in cardiovascular. Then we've got the neuroscience portfolio. You know, hey, look, in neuroscience, we're leading in every segment we're in. And we're gaining share. And on top of that, we've got meaningful innovation in almost every segment out there. If you take CST, we have Stealth Access. Stealth Access is off to a really good start. About 50% of the revenue we get in CST is coming from consumables. And the more we sell Stealth Access, the more we're going to have pull through on the consumables side. And we're super excited about that. In the neurovascular business, you know, you saw that we made progress this quarter. That's going to continue into 27. We've got a ton of innovation coming there with NeuroGuard product and with MMA. And that's going to continue going forward. And on top of that, we'll have the inorganic impact coming from the acquisitions. But expect neuroscience overall to continue to grow.

To accelerate. To accelerate.

To accelerate, yeah. Continuing in neuroscience, you know, in public health, look, AltaViva is off to a good start, and it's going to continue to grow into next year. So you can see every single franchise in neuroscience is going to accelerate going forward. And then if you look at MedSurg, look, MedSurg had a great quarter in Q4, with surgical being pretty strong, around 3%, both US and OUS. We had great performance from ACM and from Endo. Look, I think that business has great momentum. But we expect that growth to normalize a little bit, or we haven't reflected, I would say, the run rate that we see in Q4 fully in the guidance that we're taking into consideration for 27. And then to finish with MiniMed, you know, the team will comment more in detail in the following call after this, but MiniMed had a strong Q4. We expect continued strength into 27, and MiniMed should bring about sort of a 20 to 25 basis points of growth in the construction next year. So look, all in all, if you look at what happened in 26, we started the year with a 5% guidance. Gradually, we increased it to 5.5. We ended the year at 5.8. The midpoint of our guidance this year is for 27 is right at that level, 5.8. So I think we're positioning the business for success going into this year.

Hey, thanks for a very comprehensive answer. Maybe I'll limit myself to one and pass it on to others. Thank you.

Thanks, Vijay.

Thank you. And our next call comes from Larry Beagleson at Wells Fargo. Larry, please go ahead.

Good morning. Thanks for taking the question. Jeff, congrats on a strong finish here. jeff i i'm gonna ask the one question i i think that one area people are concerned about which is your taver business um you know the evolute six and seven year data did get a lot of attention this year um what what did you see or earlier this year sorry what did you see from a share standpoint in your taver business in fiscal q4 was there any differences you know us versus international and what are you assuming for your taver business you know in fiscal 27. thanks for taking the question

No, thanks for the question, Larry. I'd say, I know there's been a lot of talk on Tabr and Evolute. I'll say this. Just to repeat what Thierry said a second ago, the business has stabilized, right? Over the last eight to 10 weeks, it's been stable. We did experience a slowdown in growth, and it really was tied, we believe, to the low-risk data that came out. It's more of a US dynamic, I would say. Again, I just want to emphasize it's an older technology. It's an old procedure. The procedure tactics we've changed. And it's limited to a large size valve, which is more used in the United States. So it's not really impacting us outside the US like it is in it's stabilized. And we're moving forward now. Right. So we're heavily investing into this business. You know, we we announced, you know, a big investment last quarter. We're investing in this DOSI software where we've got Mitral and Tricuspid. And so we're we're we're feeling good going forward. We've got some some new fresh leadership there that's, you know, running fast. And so I. I don't know if you had anything to add to that, Thierry, in terms of next year.

No, I would just say, look, in Q4, we grew 6.6% despite the headwind that we had from TAVR, in particular in the U.S., as you said, Jeff. And what we've seen over the last eight weeks is a stabilization of that business, and that's what we've modeled going forward.

Thank you.

Okay. Our next question comes from Travis Steed at Bank of America. Travis, go ahead.

Hey, thanks for the question. I'll start with, you know, bed surge grew 5% this quarter, surgery grew 3% this quarter. Maybe it's how you factor these businesses in, you know, as you talked about accelerating growth next year into the guidance and to keep these businesses at kind of these higher growth levels. And on Hugo, When does that start to show up on the surge of growth? And when do you expect Yugo to start contributing positively to the margin and EPS profile versus being an R&D investment? And how do you think about the return on that program?

Well, look, I'd say, first of all, on med surgery, it was a great quarter, and it was pretty much across the board, right? The surgical business accelerated to 3%, as Thierry just pointed out. You have ACM at nearly 11%, our endo business at 9%. I mean, Mike, Marinero, and the team have done a great job building to this. And like I said, it was a great quarter. And in there, Hugo contributed, right? We had told you that we thought Hugo would have an impact towards the end of FY26, and it did in Q4. You know, we're feeling really good about the feedback we're getting on the launch. We announced this morning, you know, the submission to the new indications, general surgery, GYN, and ligature RAS. So we've got those submitted, and the feedback we're getting on the early cases is good. We're seeing the smooth case rate is up. That means how many cases, everything goes well in a case, so that's really important, especially in the US where the physicians really test the system. Our procedures are meaningfully up, and utilization continues to be strong. We've got additional placements, installations in the US, outside of the US. And complementary to this is our touch surgery platform. Installs are up 30% sequentially. We're now in over 1,400 ORs globally. This is going to be a real differentiator. I want to get to the point where we're talking about the enabling technology, not just Hugo, but all the enabling technology, including the digital piece, kind of like we do in Spine with Able. That's what we're building to. Obviously, Hugo's a big piece of that. So we're feeling very positive right now. Anything to add to that?

I think you said it all, Jeff. Great, thank you.

Thanks, Travis. All right, our next question comes from Ryan Zimmerman at BTIG. Ryan, go ahead.

Can you hear me okay?

Yep, we can hear you, Ryan.

Wonderful, thank you. So a lot of directions to go here, but I'm actually going to ask a little bit of a margin question to Thierry. You know, assuming you lap some of these tariff dynamics kind of midway through fiscal year 27, know potentially mini med is coming off and again i appreciate that you're including it for the full year but it would seem that there is opportunity potentially for a gross margin step up in 2020 particularly in the second half of 2027 and so is there anything else that you know we should be considering in terms of constraining gross margins as we think about it in the context of the 2027 guide thanks

No, so look, I think the dynamics in the gross margin are pretty similar to what we've seen so far. So kind of peeling through the different parts, we'll have negative impact from the carryover of the tariffs issue or the tariffs topic, I should say, in the first half. It's been a garbage time. To the tune of, there's someone else that's on the line, sorry. So yeah, so we'll have about 65 million to carry over coming from tariffs in the first quarter and the second quarter. To your point, we'll lap that in the second half. And then if you look at excluding tariffs operationally, we expect to continue to see pricing lift. as we did in 26. We expect to continue to see good traction from a cost of goods sold net cost out perspective. The team is gradually netting out better and better performance of cost out net of inflation. And we expect that to continue. Then we've got the mixed topic. And as you know, there are two drivers behind that. One is diabetes. To your point, if we are to separate diabetes before the end of the year, which is our intent, then we should see some lift in the gross margin rate coming from that. And then the other dimension of the mixed impact is coming from CAS. It's actually getting better because the margin of CAS is improving. And so we should see that being less of a headwind going into the second half. So look, all in all, what we've embedded in the guidance here is a gross margin that's basically flattish, slightly up excluding tariffs, or I would say very slightly up excluding tariffs, with a better performance in the second half than in the first half. And then, you know, the good news is growth is accelerating. And with growth, we're getting operating margin leverage with better absorption of the overhead. And this will come primarily from the SG&A line going into this year. So, yeah, we'll have accretion in operating margin, in particular in the second half of the year.

Thank you. Nice end to the year.

All right. Our next question comes from Josh Jennings at TD Cowen. Please go ahead, Josh.

Hi, good morning. Thanks for taking the question. I was hoping to just get a beat on the China franchise? Not the sexiest question here, but historically China has been a growth channel. There have been some headwinds of VBP for a couple of businesses, but what's the outlook for 2027? Maybe help us think about exposure there as a percentage of revenue. And is the China franchise gonna be accretive or dilutive to the organic revenue growth guidance? Thanks for taking the question.

Look, thanks for the question, Ash. We haven't gotten a China question in a while. Look, China is... We still view China as a growth market. So when we think about China, we think about it as an end market. We don't have a whole lot of exposure in terms of manufacturing in China for export outside of China. So we don't really have much exposure there. That's very small. It's really about... how it continues to be a profitable growth market for the company. And look, we've had to navigate a number of these VBP, and I think VBP is here to stay, but the worst is behind us. And the team's navigated it well. We've been able to increase the procedures and lower our costs because we're on these big contracts, these big tenders. And we'd be able to pull out costs, increase volume, even though pricing's down. And it remains growing at the corporate average right now. And that average for the company is improving, as you see. And profitability is also strong. For years, there's been this misconception that China's not profitable. Prior to VBP, I admit it was even more profitable, but it's still accretive from a profitability standpoint, and it's a growth region for the company.

Okay. All right. Next up, we have David Roman from Goldman Sachs. David, go ahead.

Thank you, Ingrid. Good morning. I wanted just to come to the comment you made on CIS during the prepared remarks. I think you talked about visualizing other catheters on Afera and how you were thinking about integration of some of the investments you're making on expanding the accessory business within CAS, as well as the potential to integrate some of the other established technologies onto Afera. And then maybe let us ask, my follow-up front here. I know, Tiara, you talked about tariffs as you reflected in the guidance, but there do seem to be a lot of other unresolved considerations on tariffs, such as USMCA and then 232. So maybe just your latest updated thoughts there would be helpful.

Well, first on CAS, I mean, or on our Afera platform, we look at it as a three-in-one kind of, we view it as the premier platform out there. And I think the numbers are bearing that out. And we've worked hard to get to this point. And we're still in the early innings of the launch of Afera in the US, as Terry pointed out, and globally. And there's a couple of vectors of growth. One is the innovation you pointed out. We're really surrounding electrophysiologists. So we have more catheters coming out, Fios 360s in Europe. We started the trial in the US for a single shot that goes right at our biggest competitor. The mapping, we just launched our second generation mapping software. And as you pointed out, David, it's got this ability to sense, pick up other catheters. And then we're bringing in, we just made two investments in an ice catheter company. So we're going to build out our ecosystem and surround the EP. In terms of if your question is about are we opening the system, I don't think we have plans for that right now. I mean, we're really... building out our proprietary technology and ensuring that we have that tight workflow. That is our plan, to have that tight workflow and get the best clinical outcomes and the best experience for the physicians.

And on the tariff side, I think we mentioned it in the commentary. Look, we continue to monitor, you know, the environment there, which is still a little volatile, as you mentioned. I think we continue to look at the 232 situation. On the flip side, you know, we've incorporated sort of a status quo in tariffs. So we haven't incorporated any potential upside for reimbursements that could occur. in which we have applied for. So we took a balanced approach on it, I would say.

Thanks, David. Our next question comes from Robbie Marcus at J.P. Morgan.

Great. Good morning. Thanks for taking the questions. Two quick ones for me. First, Jeff, I wanted to ask on MiniMed. You know, I see consensus numbers have strong organic sales growth margin and free cash flow improvements over the coming years. If that's the case, can you just remind us what's the rationale for separating it here? Wouldn't you want to keep a business with strong improvements and inflections in profitability and growth going forward?

Look, I mean, we're separating it not because of our confidence in the outlook of the business. I mean, to your point, we think it's going to do really, it's doing well today and it's going to accelerate from here with the product pipeline that they have, which I'm sure Q will give updates on the call after this. I mean, but it's the best we've seen and it's comprehensive. across all aspects of managing insulin-dependent patients. So we feel really good about that. I think as we focus, we have a lot of growth drivers to focus on. And these other growth drivers that we talked about today, whether it be Cass or Ardian, Hugo, AltaViva, Stealth Access, all of them, I think, take more advantage of and benefit from either technology platforms that cut across the company, especially in robotics and areas like that, or our commercial footprint, where MiniMed does not really capitalize on that as much. And the second is, look, we're very disciplined around capital allocation. And it's hard to constantly allocate capital to something, even though the growth is there. But the rest of Medtronic's growing much faster now. So the gap between MiniMed and the rest of Medtronic isn't as much as it used to be in terms of growth. And profitability, though, it's just a structurally lower profitable segment. And so it's kind of hard to allocate capital that way. I think both businesses... We'll do better separated. And for our own reputation and patience, We think we're separating at the right time. We've put a lot of time and money into the business. It's ready to go. It's got a great management team. And it's going to do well for patients. It's going to do well for physicians. And it's going to do well for shareholders. And the rest of Medtronic, we're accelerating, and we're going to do well as well. So we're feeling really good about that decision and excited about the future of both organizations.

maybe a quick one theory I look at consensus. I realize you just got to fiscal twenty seven I look at consensus for seven percent EPS growth for twenty twenty eight. realizing there's one fewer selling week which is 150 uh plus basis points to uh eps this year should we be thinking about a similar headwind next year and and how do you want people to think about the uh year to year there just so we could get it correct at this update appreciate the questions

Yeah, thanks, Robbie. Hey, look, we'll give 28 guidance when we give 28 guidance. It's kind of early, but just kind of directionally, you know, some of the headwinds that we've got, like tariffs, et cetera, disappear going into 28. And we expect the growth to continue, right? So we went through all the growth areas that we've got in the portfolio today. And a lot of these are in early innings, right? CAS is still going to continue to accelerate. Ardian is very early in its development. AltaViva is also very early. And then we've got a long list of innovation that's kicking in in the rest of the portfolio. So yes, there will be pressure coming from the 53rd week going away, but we have a lot of things going the other way. So we look forward to talking about that later in the year.

Great. Thank you for taking the questions.

All right. And our last question, we have time for one more. It's going to come from Mike Cracky at Learing Partners. Thank you.

Awesome. Can you hear me all right? Yep. Great. So thanks for taking my questions and congrats on the strong quarter. Maybe just one quick one, but in terms of your commercial strategy and mechanical thrombectomy, to what extent is Libra bringing differentiation to this market? How are you thinking about your ability to carve out share of the market with two well-intentioned competitors? And what could that opportunity look like?

Yeah, we try not to guide at a product level, so I can't get too specific there. But I do think we have a strong commercial footprint out there in our peripheral vascular business. And this is a product we've worked on for a while. And it's gotten great clinical results. Physician feedback is good. And I think we're putting that product in the bag of our peripheral vascular business. Plus it's got, we got this agreement with Contigo that's also helping that business. And help me, what else? And no, that's peripheral vascular. So we've got a number of new products there. It's not just one thing. So I'd look at the business and the direction of travel of the overall business. putting more competitive products in that scaled sales force. And I appreciate the question, Mike. We don't get a lot of questions around peripheral vascular, but it's kind of sneakily kind of improving their growth profile, which is part of the exciting story of Medtronic. Because you've got these three groupings. You've got these big growth drivers that we were all talking about, like CAS. And now you're going to hear more about RDN and Hugo now. But both those guys had good fourth quarters. And then you got AltaViva and Stelfaxis, these thoroughbreds coming out of the gate hot. And then you got our big businesses, CST, which we kind of just talked about. Surgery is doing well. And cardiac rhythm is just crushing it. Where other companies see a mature market, our cardiac rhythm management sees opportunity and innovates and drives the market. We're not worried about competition. It's about innovation and growing that market, lowering any kind of bar for pacing and CRM. And it's a wonderful story. But then the rest of the company is also doing well. There's puts and takes, but it's also doing well. Peripheral vascular is part of that story of adding new products to the business. And it all comes back to our capital allocation strategy of feeding the big markets and the hot hands, but also making sure that there's the right amount of capital for the rest of the businesses and focusing the portfolio to enable that, getting back to the diabetes question that Robbie had. So I appreciate the question, Mike, and I'm sure the peripheral vascular team does as well.

Understood. Thanks very much.

Great. Thanks, everyone. So with that, I think I'm going to turn the call back over to Jeff for some final remarks.

Okay. Well, first of all, thank you for joining the call and all the questions. It was a really important moment for the company as we are really accelerated and really well positioned, putting up big numbers and really well positioned for the future, and particularly in a tougher market backdrop. So I appreciate your support. and your continued interest in Medtronic. And with that, I'd say just have a great rest of your day. And thanks again.